Urine Toxicology: A Case Study Of The Lumbar

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

There is pain with lumbar flexion and extension. There is no aberrant behavior. The patient feels that he can perform increased activities of daily living with his current medications.

The patient is a 50 year old male construction worker who sustained a work-related injury while lifting heavy boxes of metals. In an office visit dated 12/14/13, patient complaints of intermittent severe low back pain which radiates to bilateral lower extremities. The claimant had an epidural injection, which significantly alleviated right leg pain for a short period of time. Unfortunately pain has returned. It is in the right leg as well as severe pain in the lower back. The claimant wishes to consider surgical intervention due to severity of pain. Objective examination reveals weakness in the right extensor halucis longus and anterior tibialis which are 4+/5. The claimant has diminished sensation along the dorsum of right foot. The claimant has a positive straight leg raise.

On examination, he has moderate pain to palpation to the lumbar spine and paravertebral muscles over the bilateral facet joints at L4-L5-S1. He has a positive straight leg raise test to the right.

Based on the progress report dated 04/05/16 by Dr. Fieser, the patient complains of pain in the left knee, left ankle and left foot, associated with numbness and tingling in the left leg/foot, as well as weakness in the left leg. He describes the pain as sharp, cutting, throbbing, dull, aching, pressure-like, cramping, shooting and shocking with muscle pain and pins-and-needles sensation.

As per medical report dated 2/18/16, patient complains of constant low back pain in a L4-5 distribution. Patient has undergone physical therapy as well as medication management without amelioration of the pain and continues to be symptomatic. He had previous epidural steroid injection. He also had acupuncture

Based on the medical report dated 12/28/15, the patient continues to report lower back pain that radiated to his left leg to his anterior/lateral thigh and anterior lower leg (shin) to his ankle and paresthesias. He has completed a conservative course of PT in which he underwent aquatic therapy. He was seen in October of

Review of diagnostic studies and medical-legal reports is included in the physician’s notes. Objective findings note that the patient is mildly obese and appears to be in moderate pain. He does not show signs of intoxication or withdrawal. His gait is antalgic gait and is assisted by cane. Lumbar range of motion is restricted with 50 degrees of flexion, 10 degrees of extension, 10 degrees of right lateral bending, and 10 degrees of left lateral bending. All range of motion is limited by pain. There is tenderness noted in the bilateral paravertebral muscles. Lumbar facet loading is positive on the left side. Ankle jerk is ¼ on the right and 2/4 on the left. Patellar jerk is ¼ on the right side and 2/4 on the left side. There is tenderness noted over the trochanter and pain to the lateral hip with range of motion. Right side motor strength of ankle dorsi flexor is 4/5 and ankle plantar flexor is 4/5. Hip flexor is 5-/5. Light touch sensation is decreased over the lateral calf on the left. Patient has resting tremor of the left lower extremity. His medications are Prilosec 20mg, Celebrex 200mg, Neurontin 800mg, Flexeril 10mg, Duragesic 75mcg/hour patch, Viagra 100mg, Nuvigil 150mg, and Silenor 6mg, Evzio 0.4 mg, and Norco

Based on the latest follow-up physiatric evaluation report dated 01/11/16, the patient complains of lower back pain which improves temporarily with PT but continues to radiate to his left leg with numbness, tingling and weakness. He attends PT three days per week and participates in a daily home exercise program.

Based on the progress report dated 03/28/16, the patient complains of pain to his lumbar

Based on the medical report dated 12/15/16, the patient complains of constant pain to her neck, bilateral shoulders and bilateral knee/leg. Pain is described as sharp, stabbing, achy and

The pain has been worsening over the left buttock area associated with tingling and numbness down to the left leg. Medical treatment to date notes physical therapy and Nonsteroidal Antiinflammatory Drugs (NSAIDs) with limited improvement. Medical history and review of system notes that the patient is significant for hypertension. Examination of the lumbar spine revealed slight loss of lumbar lordosis. On palpation, there is moderate-to-severe guarding with reproduction of deep myofascial pain on deep palpation, mostly on the left side. Pain level is 7/10 at the time of examination. Range of motion revealed forward flexion of 50 degrees, extension of 10 degrees, right lateral flexion of 20 degrees, and left lateral flexion of 20

The ROM was restricted, 50% of normal. The paraspinal muscle strength and tone was normal. The SLR was negative bilaterally. The exam of the left lower extremity was normal. The exam of the right lower extremity was normal except mild decreased strength in the right hip flexors. A reported MRI Lumbar Imaging on 07/01/15 showed multilevel degenerative changes; Previous L4 to sacrum fusion, evidence of herniated disc or significant central stenosis or foraminal stenosis. A reported MRI L Spine on 11/05/15 revealed herniated disc L2-3 with inferior extrusion impinging on the right L3 nerve root. Assessment: The patient has continuing symptoms of pain in the right lower extremity radiating down along the anterior thigh. This is consistent with the herniated disc at the L2-3 level on the right. He had previous surgery at the L2-3 level 3 years ago for his work-related

As per the orthopedic consultation report dated 08/31/15 by Dr. Phillips, the patient complains of constant right-sided low back pain. It is associated with swelling. It radiates to the right leg. She is unable to perform her activities of daily living due to pain. There is constant right leg pain. As of this report, MRI of the lumbar spine dated 8/11/2014 showed straightening of the lumbar lordosis, and mild broad base bulging annulus at the L4-5 level with a left paracentral bulging annulus extending into the neural foramen producing mild central stenosis and mild left-sided foraminal stenosis but these appear to be chronic changes. No acute epidural lesion or acute disc

As per medical report dated 4/18/16, patient complains of discomfort without bulging. Patient had attended 2 physical therapy visits. Patient also states that he is avoiding any lifting but still having the same discomfort; however, he did find the physical therapy helpful. Objective findings revealed tenderness noted in the left inguinal area. Proximal quadriceps and Sartorius region with pain on hip flexion versus resistance. Treatment plan include continuing with physical therapy for 6 to 8 more